人类遗传学导论3000字

1、人类遗传学导论论文 Systematic review to determine the barriers to and facilitators of optimal diabetes self-care and management within educational settings for children and young people with type 1 diabetesIntroductionIn this chapter we report a mixed-method systematic review that focused on self-care and ma

2、nagement of diabetes within educational settings. The review builds on the diabetes stream of the scoping review of the empirical literature conducted and reported as part of the IMP.1An important element of the original funder brief was to, when possible, include children and young people who had e

3、xperience of living away from their families. As reported in Chapter 4 on the intervention development, we were unable to achieve this ideal. A pragmatic decision was therefore made in collaboration with our funder project manager to focus the review on diabetes self-care and management wi

4、thin educational settings as an example of a context in which children have to manage their diabetes away from their families.We first briefly report a review of reviews, which confirmed that there is a gap in the evidence and provided a clear rationale for focusing on educational settings. The revi

5、ew methods, processes and findings are then reported and the chapter closes by drawing out evidence to inform the development of the EPIC intervention.Brief review of reviewsWe searched Scopus and MEDLINE for existing systematic reviews conducted over the last 10 years on the broad topic of children

6、 with T1D. The preliminary keywords that were searched are displayed in Box 25. This exercise identified 26 reviews.3,7,73,97119 The aim and focus of the reviews were contrasted in a summary table (see Appendix 3, Summary table of reviews of children and young people with type 1

7、diabetes). Published reviews covered a wide range of topics but there was little evidence on optimal diabetes self-management in educational establishments. Two recent reviews98,99found that the majority of research into managing diabetes in school investigated a broad range of issues including scho

8、ol attendance, peer relations, classroom behaviour and psychosocial status, cognitive functioning and classroom attention, levels of school achievement, teachers awareness of diabetes, on-campus nurses as resources and the educational/legal rights of students. The quality of the studies and the rese

9、arch methodology were not assessed and both of the reviews were narrative in nature. The review by Tolbert98 used a very limited keyword search.BOX 25Preliminary keywords Diabetes.Given that managing self-care away from home and parents was a key issue that we had not been able to address in fi

10、eldwork, we set out to conduct a systematic review focusing on self-care and management of T1D in children and young people within educational settings.School as a context for self-care and management of diabetesChildren and young people with T1D who are enrolled at educational establishments spend

11、a long time away from their families on a daily basis. It is important that systems are in place so that children and young people feel comfortable in these settings to confidently manage their diabetes. To optimise the childs diabetes management, school personnel must be knowledgeable about diabete

12、s self-care issues and provide an environment that promotes optimal diabetes management. As a principle of equality, the pupil with diabetes should be able to participate fully in all school activities while performing blood glucose testing, eating appropriately and administering insulin as needed.I

13、n the following sections we highlight key aspects of best practice from the UK and Europe and the USA as a general practice framework to contextualise and analyse findings. There was insufficient time and resources to describe additional country contexts, and most of the evidence mapped onto best pr

14、actice indicators originates from the UK, Europe or the USA. There was also considerable overlap from the limited number of best practice guidelines obtained and so we have assumed that there are likely to be some core similarities in a global developed country context.Policy and best practice conte

15、xt in the UK and EuropeIn the UK the DH120 recommends that all children should be supported to manage their diabetes according to their individual health-care plan and that school and early years settings should be encouraged to offer effective levels of support so that parents do not have to a

16、ttend school to administer medication. In the UK the use of individual health-care plans in educational settings is recommended to ensure that school staff are sufficiently informed about a pupils medical needs and, in relation to T1D, they should describe all parties responsibilities regarding diab

17、etes supplies and provisions.121 Common elements that current guidelines and policy documents27,33,56,120125 recommend for the management of children and young people with T1D in school are shown in Box 26.BOX 26Best practice guidelines on the management of children and young people w

18、ith T1D in UK and US schools Individualised health plan.In the UK there is no legal duty requiring school staff to administer insulin to children and young people with T1D. However, in an emergency situation or under certain circumstances school staff might be expected to administer insulin or take

19、other appropriate action. This is seen as a voluntary role, but school staff who are responsible for children and young people with T1D on a daily basis have a responsibility to ensure that children and young people remain safe and healthy while on school premises.126A DH working group examined the

20、current challenges surrounding children and young people with diabetes, producing the report Making Every Young Person with Diabetes Matter.120 The need for effective, integrated and accessible services for children and young people and their families was set out in this document.Policy an

21、d best practice context in the USAIn the US, federal law requires schools to have a trained nurse available to manage children with T1D, and the most recent guidelines for diabetes management state that at least one adult should be available for all diabetes management needs if a school nurse is una

22、vailable.127In the US a number of key publications set out the components of diabetes care at school.128,129 The American Diabetes Association128 has produced a position statement to provide recommendations for the management of children with diabetes in the school and day care setting (p.

23、 S76) and the National Diabetes Education Program publication Helping the Student with Diabetes Succeed. A Guide for School Personnel129 is designed to educate school personnel about effective diabetes management and to share a set of practices that enable schools to ensure a safe learning

24、 environment for pupils with diabetes (p. 1).The recommendations within these documents are not necessarily required by the federal laws enforced by the US Department of Education for each student with diabetes. State and local requirements in the USA vary from state to state and from school distric

25、t to school district. But it is recommended that they be used in conjunction with federal as well as state and local laws.In the USA a Diabetes Medical Management Plan (DMMP) outlines how each students diabetes will be managed. The DMMP should be used as the basis for the development of an Individua

26、lized Health Care Plan (IHP) and Emergency Care Plans for Hypoglycemia and Hyperglycemia within a school setting. Common elements that the plans are likely to address are shown in Box 26.对确定障碍的系统评价和对于糖尿病最佳的自我照顾和管理。这种管理是针对患有1型糖尿病的儿童和年轻人的教育环境。介绍：在这个章节，我们会对使用混合方法的系统的评论做一个报告。这个评论关注自我照顾和用教育背景对糖尿病的管理

27、。这个评论建立在糖尿病流行范围的以前被发表过，报告过的实证文献作为IMP的一部分。对于开始的一个简短准备的一个重要的因素是，如果有可能的话，让那些有生活经历的儿童和年轻人远离他们的家人。正如在第四节在干预的发展上所报告的那样，我们不能去完成这个理想。所以我们做了一个务实的决定，和我们投资项目的管理者合作去关注糖尿病的自我照顾和用教育背景对糖尿病的管理，把这个作为儿童必须远离他们的家人去治疗糖尿病的一个例子。我们首先对那些确信证据有差距和提供一个清晰地理由关注教育背景的评论做一个报告。评论的过程方法和结果随后被报道，章节通过提出证据去证实EPIC干预的发展去被接受。对评论的评价：我们在斯高帕斯数

28、据库和（美）联机医学文献分析和检索系统中寻找过去10年发表过的在T1D儿童主题中存在的系统评论。被找到的最初的关键词被发表在Box 25.这个联系识别26个评论。3,7,73,97119 这些评论的目的和焦点会被做成一个简易的表格并作比较（关于患有1型糖尿病的儿童和年轻人的评论的简易的表格 Appendix 3）。已发表的评论包含了广泛的题目，但是在教育机构方面，最佳糖尿病自我管理上没有证据可以表明。两个最近的评论98,99发现，对于在学校管理糖尿病的研究主体是调查范围广泛的问题。这些问题包括学校出勤率、青少年关系、课堂行为和心理状态，认知功能和课堂注意力、学业成绩、教师对

29、糖尿病的认识，校园护士作为资源和学生的合法权利。研究的质量和研究的方法没有被评估，并且评论的都是故事。评论通过Tolbert98 使用关键字搜索非常有限。初步关键词糖尿病：鉴于管理自我保健，远离家和父母是一个关键问题,我们没能解决在野外工作,我们在T1D教育背景下儿童和年轻人自我照顾和管理进行系统评论。学校作为糖尿病自我照顾和管理的一个过渡：T1D在教育机构中的儿童和年轻人在日常训练花费了很长的时间远离他们的家人。系统到位所以儿童和年轻人在帮助他们自信的治疗糖尿病的背景下感到很舒服是非常重要的。优化儿童糖尿病管理、学校人员必须了解糖尿病自我照顾的问题,并且提供一个环境促进最佳的糖尿病管理。在平等的原则下,患有糖尿病的学生应该能够全面参与学校活动而进行血糖测试,适当的进食并根据需要注射胰岛素。在接下来的部分，我们强调最好的实践的关键的方面，这些实践是从英国和欧洲和美国一般实践框架融入背景并且分析结果。这里没有足够的时间和